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Neck atonia with a focal stimulation-induced seizure arising from the SMA: pathophysiological considerations.

Kovac, S; Nachev, P; Rodionov, R; Scott, C; McEvoy, AW; Toms, N; Wehner, T; ... Diehl, B; + view all (2012) Neck atonia with a focal stimulation-induced seizure arising from the SMA: pathophysiological considerations. Epilepsy & Behavior , 24 (4) 503 - 506. 10.1016/j.yebeh.2012.05.012. Green open access

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Abstract

A 28-year-old patient with pharmacoresistant non-lesional right frontal epilepsy underwent extra-operative intracranial EEG recordings and electrical cortical stimulation (ECS) to map eloquent cortex. Right supplementary motor area (SMA) ECS induced a brief seizure with habitual symptoms involving neck tingling followed by asymmetric tonic posturing. An additional feature was neck atonia. During atonia and sensory aura, discharges were seen in the mesial frontal electrodes and precentral gyrus. Besides motor signs, atonia, although rare and not described in the neck muscles, and sensations have been reported with SMA stimulation. The mechanisms underlying neck atonia in seizures arising from the SMA can be explained by supplementary negative motor area (SNMA) - though this was not mapped in electrodes overlying the ictal onset zone in our patient - or primary sensorimotor cortex activation through rapid propagation. Given the broad spectrum of signs elicited by SMA stimulation and rapid spread of seizures arising from the SMA, caution should be taken to not diagnose these as non-epileptic, as had previously occurred in this patient.

Type: Article
Title: Neck atonia with a focal stimulation-induced seizure arising from the SMA: pathophysiological considerations.
Location: US
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.yebeh.2012.05.012
Publisher version: http://dx.doi.org/10.1016/j.yebeh.2012.05.012
Language: English
Additional information: This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Adult, Brain Mapping, Electric Stimulation, Electroencephalography, Female, Humans, Magnetic Resonance Imaging, Motor Cortex, Neck Muscles, Seizures
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Experimental Epilepsy
URI: https://discovery.ucl.ac.uk/id/eprint/1366964
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